Volunteer Registration Form

Thank your for your interest in volunteering with R.O.C.K.! Please fill out the fields to the best of your ability. If you have any questions please email volunteer@rocksf.org.

First Name Last Name Email Phone Birth Date(MM/DD/YYYY) / / If you are volunteering with a group, please let us know the name of the organization Do you have Medical Insurance? All R.O.C.K. Volunteers are required to have medical insurance. COVID-19 Vaccine Card

Yes

Carrier & Policy Number Have you been convicted of a felony?(Answering yes will not automatically prohibit individuals from becoming volunteers, but will be considered with respect to time, circumstances, seriousness and relationship to volunteer responsibilities.) If yes, please explain Emergency Contact Name Emergency Contact Phone Emergency Contact Relationship

My signature below certifies that all statements made on this application are true, complete and correct to the best of my knowledge and belief. I understand these statements are subject to verification. I understand that falsification on this application can disqualify me from consideration or result in my volunteer services being denied. Furthermore, my signature below provides my authorization to R.O.C.K. to conduct driver license and motor vehicle record checks as needed, as well as reference checksto determine my suitability for placement.

I hereby release all parties from any liability for furnishing this information.

Date

Photo Permission

By checking this box I give R.O.C.K. permission to use pictures of me on thank you cards, website, newspaper, television and/or any other marketing/media materials about R.O.C.K.. Not checking this box will not effect your eligibility to volunteer.

Yes

I agree

R.O.C.K. acknowledges that equal opportunity for all persons is a fundamental human value. Each volunteer applicant will be considered on the basis of individual ability and merit, without regard to race, color, age, religion, national origin, disability, sexual orientation, gender, or marital status.

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